Laparoscopic partial nephrectomy is the recommended treatment for tumors smaller than 4cm in cases where it is feasible. Depending on the location of the tumor, the transabdominal or direct retroperitoneal pathway may be considered.

Objective

To compare the transperitoneal (TPPN) and direct retroperitoneal (RPPN) partial nephrectomies performed between 2007 and 2016.

Material and methods

A retrospective study was conducted on 71 patients who underwent TPPN (42) or direct RPPN (29) partial nephrectomy. We evaluated the characteristics of the patients and tumors, including tumor complexity (PADUA, RENAL, C-index). We compared perioperational variables, including the complications between the 2 pathways.

Results

We found no differences in terms of age, sex, Charlson's score and BMI. A larger proportion of patients in the direct RPPN group had prior major abdominal surgery (7.1 vs. 24.1%; p=0.043). There were no differences in tumor size, laterality, polarity or complexity in any of the assessed scores. There were significant differences in tumor location (anterior/middle/posterior) between the TPPN and RPPN groups (54.8/31/14.3 vs. 3.4/13.8/82.8%; p<0.001). There were no differences in the surgical time or length of stay. The TPPN group had a smaller urinary tract opening (4.8 vs. 27.6%; p=0.007) and a higher percentage of haemostatic renorrhaphy (47.6 vs. 17.2%; p=0.008). There were no differences in the need for warm ischemia, in the changes in hemoglobin levels or in the glomerular filtration rate. The complication rates were similar for the two series.

Conclusion

The two pathways show similar results in terms of renal function preservation, complications and oncological results. However, we recommend understanding both techniques and adapting the access type to the clinical case.